Individual
MS. JO ANN FORRISTAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CFNP
Contact information
Practice address
3735 HWAY 95, BULLHEAD CITY, AZ 86442-8199
(928) 444-1444
Mailing address
PO BOX 1270, CORNVILLE, AZ 86325-1270
(314) 412-3791
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
098041
MO
363LF0000X
Family Nurse Practitioner
Primary
AP4497
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425769213
—
MO
Enumeration date
06/04/2006
Last updated
11/18/2014
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